Health Assessment Jarvis Final Updated
& Combined 2022 (Answered)
1. A hospitalized patient does not require a full neurologic examination during every shift
assessment. What is a method of assessing the neurologic status of a patient without
performing a full neurological examination?
a. Palpate the carotid pulse.
b. Offer the patient a glass of water.
c. Look at the significant other throughout the examination.
d. Assign the nursing assistant to ask the patient questions and report the findings.
b
A physician tells the nurse that a patient's vertebra prominens is tender and asks the
nurse to reevaluate the area in 1 hour. The area of the body the nurse will assess is:
a.Just above the diaphragm.
b.Just lateral to the knee cap.
c.At the level of the C7 vertebra.
d.At the level of the T11 vertebra.
C
The C7 vertebra has a long spinous process, called the vertebra prominens, which is
palpable when the head is flexed.
1. The nurse is assessing an older adult's functional ability. Which definition correctly
describes one's functional ability?
a. It denotes an older person's cognitive level.
b. It is the measure of the expected changes of aging that one is experiencing.
c. It describes the individual's motivation to live independently.
d. It refers to one's ability to perform activities necessary to live in modern society.
d
After completing an initial assessment of a patient, the nurse has charted that his
respirations are eupneic and his pulse is 58 beats per minute. These types of data
would be:
a.
Objective.
b.
Reflective.
c.
Subjective.
d.
Introspective.
A
The nurse is reviewing the development of culture. Which statement is correct regarding
the development of one's culture? Culture is:
,a.
Genetically determined on the basis of racial background.
b.
Learned through language acquisition and socialization.
c.
A nonspecific phenomenon and is adaptive but unnecessary.
d.
Biologically determined on the basis of physical characteristics.
B
The nurse is conducting an interview with a woman who has recently learned that she is
pregnant and has come to the clinic today to begin prenatal care. The woman states
that she and her husband are excited about the pregnancy but have a few questions.
She looks nervously at her hands during the interview and sighs loudly. Considering the
concept of communication, the nurse knows that which statement is most accurate?
The woman:
1. is excited about her pregnancy but nervous about labor.
2. is exhibiting verbal and nonverbal behavior that does not match.
3. is excited about her pregnancy but her husband is not and this is upsetting to her.
4. is not excited about her pregnancy but believes the nurse will respond negatively to
her if she states this.
ANS: 2
Communication is all behavior, conscious and unconscious, verbal and nonverbal. All
behavior has meaning.
The nurse is preparing to conduct a health history. Which of these statements best
describes the purpose of a health history?
a.To provide an opportunity for interaction between the patient and the nurse
b.To provide a form for obtaining the patient's biographic information
c.To document the normal and abnormal findings of a physical assessment
d.To provide a database of subjective information about the patient's past and current
health
D
During an examination, the nurse can assess mental status by which activity?
a. Examining the patients electroencephalogram
b. Observing the patient as he or she performs an intelligence quotient (IQ) test
c. Observing the patient and inferring health or dysfunction
,d. Examining the patients response to a specific set of questions
C
1. A woman has come to the clinic to seek help with a substance abuse problem. She
admits to using cocaine just before arriving. Which of these assessment findings would
the nurse expect to find when examining this woman?
a. Dilated pupils, pacing, and psychomotor agitation
b. Dilated pupils, unsteady gait, and aggressiveness
c. Pupil constriction, lethargy, apathy, and dysphoria
d. Constricted pupils, euphoria, and decreased temperature
ANS: A
A cocaine users appearance includes pupillary dilation, tachycardia or bradycardia,
elevated or lowered blood pressure, sweating, chills, nausea, vomiting, and weight loss.
The persons behavior includes euphoria, talkativeness, hypervigilance, pacing,
psychomotor agitation, impaired social or occupational functioning, fighting, grandiosity,
and visual or tactile hallucinations.
When performing a physical assessment, the first technique the nurse will always use
is:
a.
Palpation.
b.
Inspection.
c.
Percussion.
d.
Auscultation.
B
The nurse is performing a general survey. Which action is a component of the general
survey?
A) Observing the patient's body stature and nutritional status
B) Interpreting the subjective information the patient has reported
C) Measuring the patient's temperature, pulse, respirations, and blood pressure
D) Observing specific body systems while performing the physical assessment
A
Which of these statements is true regarding the vertebra prominens? The vertebra
prominens is:
the spinous process of C7
1. At the beginning of rounds, when the nurse enters the room, what should the nurse
do first?
, A. Check the intravenous infusion site for swelling or redness.
B. Check the infusion pump settings for accuracy.
C. Make eye contact with the patient and introduce himself or herself as the patient's
nurse.
D. Offer the patient something to drink
ANS: C
As a mandatory reporter of elder abuse, which of these must be present before a nurse
notifies the authorities?
ANS: Suspicion of elder abuse and/or neglect
Many health care workers are under the erroneous assumption that proof is required
before notification of suspected abuse can occur. Only a suspicion of elder abuse or
neglect is necessary.
The sac that surrounds and protects the heart is called the:
a.
Pericardium.
b.
Myocardium.
c.
Endocardium.
d.
Pleural space.
ANS: pericardium.
The pericardium is a tough fibrous double-walled sac that surrounds and protects the
heart. It has two layers that contain a few milliliters of serous pericardial fluid.
The nurse needs to pull the portion of the ear that consists of movable cartilage and
skin down and back when administering eardrops. This portion of the ear is called the:
a. Auricle.
b. Concha.
c. Outer meatus.
d. Mastoid process.
A. auricle
The external ear is called the auricle or pinna and consists of movable cartilage and
skin.
The nurse recognizes which of these persons is at greatest risk for undernutrition?
a.
5-month-old infant
b.
50-year-old woman
c.
& Combined 2022 (Answered)
1. A hospitalized patient does not require a full neurologic examination during every shift
assessment. What is a method of assessing the neurologic status of a patient without
performing a full neurological examination?
a. Palpate the carotid pulse.
b. Offer the patient a glass of water.
c. Look at the significant other throughout the examination.
d. Assign the nursing assistant to ask the patient questions and report the findings.
b
A physician tells the nurse that a patient's vertebra prominens is tender and asks the
nurse to reevaluate the area in 1 hour. The area of the body the nurse will assess is:
a.Just above the diaphragm.
b.Just lateral to the knee cap.
c.At the level of the C7 vertebra.
d.At the level of the T11 vertebra.
C
The C7 vertebra has a long spinous process, called the vertebra prominens, which is
palpable when the head is flexed.
1. The nurse is assessing an older adult's functional ability. Which definition correctly
describes one's functional ability?
a. It denotes an older person's cognitive level.
b. It is the measure of the expected changes of aging that one is experiencing.
c. It describes the individual's motivation to live independently.
d. It refers to one's ability to perform activities necessary to live in modern society.
d
After completing an initial assessment of a patient, the nurse has charted that his
respirations are eupneic and his pulse is 58 beats per minute. These types of data
would be:
a.
Objective.
b.
Reflective.
c.
Subjective.
d.
Introspective.
A
The nurse is reviewing the development of culture. Which statement is correct regarding
the development of one's culture? Culture is:
,a.
Genetically determined on the basis of racial background.
b.
Learned through language acquisition and socialization.
c.
A nonspecific phenomenon and is adaptive but unnecessary.
d.
Biologically determined on the basis of physical characteristics.
B
The nurse is conducting an interview with a woman who has recently learned that she is
pregnant and has come to the clinic today to begin prenatal care. The woman states
that she and her husband are excited about the pregnancy but have a few questions.
She looks nervously at her hands during the interview and sighs loudly. Considering the
concept of communication, the nurse knows that which statement is most accurate?
The woman:
1. is excited about her pregnancy but nervous about labor.
2. is exhibiting verbal and nonverbal behavior that does not match.
3. is excited about her pregnancy but her husband is not and this is upsetting to her.
4. is not excited about her pregnancy but believes the nurse will respond negatively to
her if she states this.
ANS: 2
Communication is all behavior, conscious and unconscious, verbal and nonverbal. All
behavior has meaning.
The nurse is preparing to conduct a health history. Which of these statements best
describes the purpose of a health history?
a.To provide an opportunity for interaction between the patient and the nurse
b.To provide a form for obtaining the patient's biographic information
c.To document the normal and abnormal findings of a physical assessment
d.To provide a database of subjective information about the patient's past and current
health
D
During an examination, the nurse can assess mental status by which activity?
a. Examining the patients electroencephalogram
b. Observing the patient as he or she performs an intelligence quotient (IQ) test
c. Observing the patient and inferring health or dysfunction
,d. Examining the patients response to a specific set of questions
C
1. A woman has come to the clinic to seek help with a substance abuse problem. She
admits to using cocaine just before arriving. Which of these assessment findings would
the nurse expect to find when examining this woman?
a. Dilated pupils, pacing, and psychomotor agitation
b. Dilated pupils, unsteady gait, and aggressiveness
c. Pupil constriction, lethargy, apathy, and dysphoria
d. Constricted pupils, euphoria, and decreased temperature
ANS: A
A cocaine users appearance includes pupillary dilation, tachycardia or bradycardia,
elevated or lowered blood pressure, sweating, chills, nausea, vomiting, and weight loss.
The persons behavior includes euphoria, talkativeness, hypervigilance, pacing,
psychomotor agitation, impaired social or occupational functioning, fighting, grandiosity,
and visual or tactile hallucinations.
When performing a physical assessment, the first technique the nurse will always use
is:
a.
Palpation.
b.
Inspection.
c.
Percussion.
d.
Auscultation.
B
The nurse is performing a general survey. Which action is a component of the general
survey?
A) Observing the patient's body stature and nutritional status
B) Interpreting the subjective information the patient has reported
C) Measuring the patient's temperature, pulse, respirations, and blood pressure
D) Observing specific body systems while performing the physical assessment
A
Which of these statements is true regarding the vertebra prominens? The vertebra
prominens is:
the spinous process of C7
1. At the beginning of rounds, when the nurse enters the room, what should the nurse
do first?
, A. Check the intravenous infusion site for swelling or redness.
B. Check the infusion pump settings for accuracy.
C. Make eye contact with the patient and introduce himself or herself as the patient's
nurse.
D. Offer the patient something to drink
ANS: C
As a mandatory reporter of elder abuse, which of these must be present before a nurse
notifies the authorities?
ANS: Suspicion of elder abuse and/or neglect
Many health care workers are under the erroneous assumption that proof is required
before notification of suspected abuse can occur. Only a suspicion of elder abuse or
neglect is necessary.
The sac that surrounds and protects the heart is called the:
a.
Pericardium.
b.
Myocardium.
c.
Endocardium.
d.
Pleural space.
ANS: pericardium.
The pericardium is a tough fibrous double-walled sac that surrounds and protects the
heart. It has two layers that contain a few milliliters of serous pericardial fluid.
The nurse needs to pull the portion of the ear that consists of movable cartilage and
skin down and back when administering eardrops. This portion of the ear is called the:
a. Auricle.
b. Concha.
c. Outer meatus.
d. Mastoid process.
A. auricle
The external ear is called the auricle or pinna and consists of movable cartilage and
skin.
The nurse recognizes which of these persons is at greatest risk for undernutrition?
a.
5-month-old infant
b.
50-year-old woman
c.
